Swimming induced pulmonary edema (SIPE)

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SIPE, which is also known as Immersion Pulmonary Edema, has been occasionally reported during the last two decades. It may affect scuba divers, breath-hold divers and swimmers. The incidence of SIPE is probably underestimated, because mild cases may resolve on their own and the most severe cases may be mistaken for drowning or cardiac-related death. Two recent papers present three documented and unusual cases of SIPE.

Case 1

A 33-year-old healthy military diver was immersed for 10 minutes in 50 F (10 C) while wearing a 5 mm neoprene wetsuit. After two breath-hold dives to 18 ft (6 m) for 0.5-1 min duration with a surface interval of 1 min, he noted wheezing and coughed pink, frothy sputum. At admission to a hospital, he had already improved but imaging of his lungs showed obvious signs of SIPE. This was an unusually short exposure, shallow dive and quick onset of symptoms.1

Case 2

A 46-year-old man was spearfishing in 5 m of water in a 5 mm neoprene wetsuit. He did not report feeling cold, although the water was 57.2 F (14 C).While swimming back to shore against strong current for only two minutes, he suddenly felt such respiratory distress that he could not call for help or swim. His wife brought him back to shore; he was unconscious. He recovered in a few hours and was discharged from the hospital after three days.2

Case 3

A 48-year-old man was performing an 800-m swim test. The day before, during the same exercise he reported becoming severely breathless, but recovered within a short period of time. On his next attempt, he had to swim 500 m with a snorkel while wearing his complete scuba equipment. After 250 m his buddy discovered he was unconscious and sinking. An emergency medical team responded quickly and properly, but he was in a coma when admitted to a hospital where he was kept in artificially induced protective hypothermia (the initial diagnosis was cardio-circulatory arrest and drowning).2

In all three cases, the victims recover – some sooner, others later. Medical causes, except hypertension in the first case, could not be identified; all victims appeared to be in normal health, except for the findings of lung edema.

The lesson learned is that SIPE may occur suddenly and be very severe. It can be life threatening while in water and it may require intensive care to recover. The apparently low incidence of SIPE may be due to misidentification of some fatalities as a cardiac-related death instead of SIPE.

Authors suggest two major points to prevent SIPE and fatal outcome in case of it:

  •  Do not struggle against a strong current; maintaining a good respiration is better than increasing the swimming effort.
  • Always have diving or swimming buddy.

To learn more, read “Immersion Pulmonary Edema.”

Studies referenced in this post:

  1.  Gempp E. et al. Pulmonary oedema in breath-hold diving: an unusual presentation and computed tomography findings. Diving Hyperb Med 2013; 43:162-163.
  2. Cochard G. et al. Swimming-induced immersion pulmonary edema while snorkeling can be rapidly life-threatening: Case reports. UHM 2013; 40(5): 411-415

Post written by: Petar Denoble, MD, D.Sc.

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